This inspection took place on 28 September 2017 and was unannounced. Abbotsford - Pinner is a care home for older people providing accommodation and care for up to 24 people. At the time of our inspection there were 19 people using the service.

At our inspection on 28 and 30 September 2016 we rated the service as “Requires Improvement”. We found breaches in respect of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to risk assessments and regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to quality assurance specifically audits.

We then undertook a follow up inspection on 9 January 2017 to check whether the home had made improvements to their risk assessments. During this inspection we found that the service had met the legal requirement in respect of this.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection on 28 September 2017, we found that the home had taken appropriate action and made improvements in relation to risk assessments, quality assurance checks and documentation.

People and their relatives informed us that they were satisfied with the care provided in the home. People told us that they had been treated with respect and felt safe living in the home. There was a very positive atmosphere within the home. The welfare of people was at the centre of the home. Management and staff worked well together to ensure people had a meaningful and enjoyable life.

Our inspection in September 2016 found that risks to people were not always identified and risk assessments contained limited information. They also lacked information about preventative actions that needed to be taken to minimise risks. During our follow-up inspection in January 2017, we found that the home had reviewed risk assessments and made necessary improvements. During this comprehensive inspection in September 2017, we found that the home continued to ensure risk assessments included sufficient detail and reflected potential risks to people as well as providing guidance for staff on how to mitigate the risks.

Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

On the day of our inspection we observed that there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. Staff told us that staffing levels were adequate and that they had enough staff to carry out their duties. The registered manger informed us that staffing levels were regularly reviewed depending on people's needs and occupancy levels and at the time of the inspection there were sufficient staffing levels.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

During our inspection in September 2016, we found deficiencies in relation to some aspects of health and safety in the home. During this inspection in September 2017, we found that the home had taken appropriate action and addressed these issues.

Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency. Care workers prepared appropriate and up to date care plans which involved people and their representatives. People's healthcare needs were carefully monitored and attended to.

We found the premises were clean and tidy and there were no unpleasant odours throughout th

We carried out an unannounced comprehensive inspection of this service on 28 and 30 September 2016 at which there were breaches of legal regulations. For one of those breaches we issued the service with a warning notice. This was in relation to the assessment of risks to the health and safety of people using the service not being carried out appropriately. We found that risks were not consistently being identified for people and their specific needs which meant risks were not being managed effectively.

We undertook an unannounced inspection on the 9 January 2017 to check whether the service had met the warning notice and to confirm that they now met legal requirement. We inspected the safe domain only at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Abbotsford - Pinner' on our website at www.cqc.org.uk'.

Abbotsford - Pinner is a care home for older people providing accommodation and care for up to 24 people.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this focused inspection on 9 January 2017, the service demonstrated that they had taken sufficient action to comply with the warning notice and that the legal requirements had been met.

We found that risk assessments included more detail and reflected potential risks to people. We saw evidence that the service had appropriate risk assessments for people which included mobility, mobility equipment, medicines administration and diabetes where necessary. Risk assessments also included information about preventative actions that needed to be taken to minimise risks as well as measures for staff on how to support people safely.

We need to be sure that the service is able to demonstrate that they are able to consistently meet Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will therefore look at this Regulation again at the next comprehensive inspection we carry out.

This inspection took place on 28 and 30 September 2016 and was unannounced. Abbotsford - Pinner is a care home for older people providing accommodation and care for up to 24 people. At the time of out inspection there were 20 people using the service.

At our last inspection on 19 October 2015 we rated the service as “Requires Improvement”. We found a breach in respect of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staff supervisions, appraisals and staff training. We also made a recommendation in respect of medicines storage temperate checks and audits.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives informed us that they were satisfied with the care and services provided in the home. During the inspection we observed that people were well cared for and appropriately dressed. People who used the service said that they felt safe in the home and around staff. Relatives of people who used the service told us they were confident that people were safe in the home.

Individual risk assessments were completed for people. However, the assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments. This could result in people receiving unsafe care and we found a breach of regulations in respect of this.

Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

On the days of the inspection we observed that there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. Staff told us that staffing levels were adequate and that they had enough staff to carry out their duties. However, some people who used the service told us that there were inadequate staffing levels. We discussed this with the registered manger and she informed us that staffing levels were regularly reviewed depending on people's needs and occupancy levels and at the time of the inspection there were sufficient staffing levels.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal. At the last inspection we made a recommendation in respect of temperature checks of the medicines cupboard. During this inspection in September 2016 we found the home had implemented daily temperature checks and these were recorded.

We looked at various aspects of health and safety in the home and found some deficiencies. The gas boiler safety certificate expired in May 2015 and we discussed this with the registered manager who explained that this had been an oversight and that an appointment had been scheduled. Documents confirmed that a fire drill had been carried out in March 2015 and then in May 2016. There was no documented evidence to confirm that a fire drill had been carried out between this period of 14 months.

Personal emergency and evacuation plans (PEEP) had been prepared for people who used the service.

Weekly fire alarms had been recorded but we found there were a number of occasions where the fire alarms had not been tested weekly. We raised this with the registered manager and she confirmed that this had been an oversight. .

We found the premises were clean and tidy and there were no unpleasant odours. However we found that there was a lack of documented records to confirm that some essential maintenance had been car

This inspection took place on 19 October 2015 and was unannounced. Abbotsford – Pinner is a care home for older people providing accommodation and care for up to 24 people. At the time of our inspection, there were 19 people using the service.

The provider met all the standards we inspected against at our last inspection on 1 May 2014.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Positive caring relationships had developed between people who used the service and staff and during the inspection we observed people were treated with kindness and compassion. People who used the service told us they felt safe in the home and around staff. Relatives of people who used the service told us that they were confident that people were safe in the home and around staff. Systems and processes were in place to help protect people from the risk of harm.

There were enough staff to meet people’s individual care needs and this was confirmed by staff we spoke with. The majority of people who used the service told us that there were enough staff available. On the day of the inspection we observed that staff did not appear to be rushed and were able to complete their tasks.

People told us that they had been given their medicines as prescribed. There were arrangements for the recording of medicines received into the home and for their storage, administration and disposal. However, we noted that regular temperature checks had not been carried out to ensure that medicines were stored at the right temperature. We also found that regular medicine audits were not documented and therefore there was a lack of evidence to confirm that these took place. We found that there were some gaps in the medicines administration charts and no recent audit had taken place to identify these shortfalls.

Staff spoke positively about their experiences working at the home. They said they felt supported by management within the home and said that they worked well as a team. However we noted that there was a lack of evidence to confirm that staff had received regular supervision sessions consistently over the last year. We also noted that staff had not received an appraisal since our last inspection. We were provided with a training matrix detailing what training staff had received. Some staff had received training in areas such as safeguarding, infection control and medicine administration. However we noted that some of the training received was out of date and refresher training was required.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were also noted and staff we spoke with were aware of people’s likes and dislikes. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people. People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly and were updated when people’s needs changed.

The majority of staff we spoke with had a basic understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people’s care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that where people were potentially being deprived of their liberties, the home had taken the necessary action to ensure that these were authorised appropriately.

The majority of people we spoke with were positive about the food in the home. Food looked appetising and was presented well and we noted that the food was freshly prepared. Staff were aware of special diets people required either as a result of a clinical need or a cultural preference.

People spoke positively about the atmosphere in the home and we observed that the home had a homely atmosphere. Bedrooms had been personalised with people’s belongings to assist people to feel at home.

People we spoke with told us there were generally sufficient activities available for them to participate in. We noted that there was not a formal activities timetable and the manager explained that this was because activities depended on what people wanted to do daily. We spoke with the activities coordinator and she explained that she organised activities that people were interested in. She told us that people enjoyed card games, quizzes and karaoke.

We noted that a formal satisfaction survey had not been carried out in 2015 and discussed this with the manager. She explained that questionnaires had been given to people in respect of the food and we saw evidence of this. Satisfaction surveys had not been carried out in respect of the overall care received. She confirmed that a survey would be carried out by the end of 2015.

We found the home had a management structure in place with a team of care staff, the deputy manager and the manager. Staff told us that the morale within the home was good and that staff worked well with one another. Staff spoke positively about working at the home. They told us management was approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the manager.

Staff were informed of changes occurring within the home through staff meetings and we saw that these meetings occurred quarterly and were documented. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings. Staff also said they did not wait for the team meeting to raise queries and concerns. Instead, they told us they discussed issues daily at an informal catch up meeting.

The home had a quality assurance policy. However we noted that the policy was not comprehensive and did not provide detailed information on the systems in place for the provider to obtain feedback about the care provided at the home.

We noted that there was a lack documented evidence to confirm that regular audits were carried out by the provider. There was a lack of documented evidence to confirm that regular health and safety checks in respect of the premises, housekeeping, infection control, policies and procedures and staff training, supervisions and appraisals were carried out. We spoke with the manager about this and she confirmed that such checks were carried out but these were informal and had not been recorded.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

Is the service safe?

There were procedures in place to protect people from abuse and that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were enough staff on duty to meet the needs of the people living at the home and there were adequate arrangements in place to deal with foreseeable emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, we found that the manager was aware of the recent changes in legislation due to a recent court decision. The manager told us they had plans to review whether applications should be made in light of these changes.

Is the service effective?

We found that people’s needs were identified and their care was planned in a way to meet their assessed needs. The care plans were available and were evaluated on a regular basis. People’s individual needs, choices and preferences were reflected in their care plans. People’s health was monitored and they received medical attention when it was needed.

Is the service caring?

We observed during our inspection that people were treated with respect and care plans had been written and developed with the involvement of the people using the service and their relatives.

People told us that they were happy with the staff and the support that was provided to them. They told us “If I weren’t happy I would have moved”, “The care is very good” and that the home was “fantastically run”. They also told us “The food is exceptional”, “I’m very happy here” and that the “Staff are very good and I get on with them very well”.

We found that the service actively sought, listened to and acted on people’s views and decisions. The feedback we received was that people were listened to and changes were made to their care and support accordingly.

During our inspection, we saw people’s privacy, dignity and independence were respected.

Is the service responsive?

We observed people being treated kindly and with patience. People who used the service told us that they were enabled to maintain relationships with their friends and relatives. We found that people, their relatives and friends were encouraged to provide feedback.

We found that the service responded appropriately to accidents and that appropriate referrals were made and actions taken to promote people’s health and well-being.

Is the service well led?

There was a system in place to monitor the service to ensure people’s well-being and that the quality of the service was adequate. We spoke with five members of the staff who told us that they enjoyed working at the home and had not raised any issues or concerns regarding their work.

We found that the service worked in partnership with people’s GP and district nurses in order to ensure people’s health and well-being. We spoke with a district nurse who regularly visited the home to provide treatment. Their comments included that the home was “always clean and tidy, never smells”, “people are well looked after” and the “staff know the needs of the residents”. The nurse felt they “worked in partnership” and had “no concerns” regarding the well-being of the people who lived at the home.

We spoke with four people who use the service and three members of staff including the manager.

All the people we spoke with told us they had not been involved in choosing their lunch that day. One person said the provider held meetings with people who use the service and these meetings discussed any issues. We observed people being asked what they would like to drink and whether they would like to be involved in the organised activity that day. We found people consented to their care and people's capacity to make decisions had been assessed.

People who use the service told us they enjoyed the food and drink that were provided. They said they got a choice of lunch some days of the week. One person said they "never go thirsty". We observed staff ensuring people enjoyed the food and drink provided. People always had a drink available and people's specific nutritional needs were met.

People were aware of the medication they were taking and said they received these on time. Some people were able to take their own medication with appropriate monitoring to ensure they were safe. Medication was stored appropriately but was not always correctly recorded.

We found staff were appropriately checked before they were employed. However these checks were not always updated appropriately.

All the staff and provider records were accurate and fit for purpose. All the care plans we reviewed had relevant information for staff to be able to provide safe care.

We spoke with six people who use the service. They all said they were happy with the service and the staff. One person told us they were ‘confident’ in the manager and that ‘the staff do not let you down’. Another person said they had ‘fallen in love with the room’.

All the people we spoke with said they got all the items to keep them occupied that they required including any reading material. Four people said they enjoyed and got a choice of meals although two others said they got no choice. Two people who use the service also said they did not get visited by any religious representatives even though they wanted one. All the people spoken to said they had had not had concerns since they had been using the service. Two out of three people said they had not taken part in a satisfaction survey although four people said meetings were arranged by the service for them where they got to vote and have their say on the running of the service including any planned activities or visits.

All the people said social and recreational activities were arranged for them, such as going out into the community and attending concerts in the home. However two people said the activities were not varied. Another person said there was ‘very little social activity’. Three people said they were cared for by their regular carer although two said there were shortages of staff. One person said different staff cared for them each day.